AUSTIN (Nexstar) — A new kind of insurance has hit the Texas marketplace, and it targets infertility.
It’s billed as the country’s first individual health policy exclusively insuring primary infertility treatments for the next generation. Austin-based LifeSpring has created the plan, which its founders said is the only policy in the nation available outside of a healthcare benefits plan.
Jason Muesse and Eugenia Shea, who both work in medical malpractice insurance, developed this plan over five years.
“I was visiting with friends and family and colleagues and I was hearing a little bit about their struggles with infertility,” said Muesse, LifeSpring’s CEO.
“I was an insurance professional, and I started thinking about the issues and I did a little research and realized there are not a lot of options out there for people,” he continued. “So, I started trying to see if I could use my insurance expertise to solve the problem.”
They set their sights on the next generation, developing a policy with children and grandchildren in mind.
The policy is designed to be purchased for children under the age of 13.
According to a company spokesperson, coverage begins after both members of the couple reach the age of 18 and before the member being treated for a covered condition reaches the age of 36. On the 36th birthday of the member, the couple has one year to use any remaining money for treatments.
“It is an early life policy,” Shea, the CBO, said.
“We chose those times of life because in insurance it is important to have a spread of risk, and the three times that we know we are in fertile is at birth, at puberty, and when we are trying to conceive,” she explained.
LifeSpring’s policy consists of a one-time payment of approximately $2,000, which covers $50,000 when it activates. Beneficiaries must be diagnosed with primary infertility, meaning the person is not able to get pregnant after 12 months of unprotected sex.
“Infertility is very expensive,” Muesse said, adding that the span from infertility diagnosis to live birth can cost, on average, $42,000.
“That’s just not possible for a lot of people,” he said. “So, we are really excited that we are going to be able to give them the opportunity for less than $2,000.”
The coverage does not include adoption costs, but it does include costs covering medication, doctor visits, in vitro fertilization, intrauterine insemination, anesthesia, egg/sperm/embryo storage, and other related treatments up to $50,000 with no deductibles or coinsurance.
“When you figure one in eight people is going to have this problem, there’s a lot of stories that are not told,” She said. “This is the path to parenthood for some of those people for our future generations.”
Cedar Park mom Sandy Knott bought the insurance for her 13-year-old son.
“If I can play on his future I will,” Knott, a former coworker of Muesse and Shea in their other business, said.
“I’ve had a lot of friends who have struggled with infertility,” Knott explained.
“I was one of the very blessed ones who did not,” she continued. “Just to watch them struggle through the financial hardships and making the decisions — of how many more rounds do we go, how do we make this happen— it was an easy decision for me to make this decision to buy my son a policy.”
“I can’t predict the future, and I can’t predict the unknown,” Knott said. “But if I can make his life a little bit easier in anyway I can, this is just one extra thing to do.”
LifeSpring’s policy was approved by the Texas Department of Insurance this year as a “specified disease policy sold in the individual market,” according to an agency spokesperson.
TDI spokesperson Jerry Hagins said some major medical insurance politics contain coverage for in vitro fertilization procedures.
“Insurers are required to offer coverage in the context of employer plans, not individual coverage,” Hagins wrote in an email. “Because it’s a mandated offer not a mandated benefit, the policyholder [employer or association] can choose to decline the coverage.”
Hagins said many employers opt out, since accepting the coverage would come with a higher premium cost.
“My company has really great benefits, but we don’t have any type of infertility coverage other than if you were going through infertility now,” Knott said. “You would be able to have basic coverage, I think, for a very minimal first few steps, I don’t think it takes you all the way through in vitro.”
“We don’t know what insurance is going to cover in the future,” she said. “It’s just a nice safety net for me.”
“It is odd thinking about my 13-year-old who can’t think about anything other than baseball and video games, to think about what is he going to be like and what will the struggles be in his life when it is time for him and his future person to start a family,” she said.
The LifeSpring team plans to expand the coverage to other states in 2020.
A message to the Fertility Foundation of Texas for comment was not immediately returned on Friday.